Laparoscopic Hernia Repair Research Articles

Laparoscopic repair for a recurrent epigastric incisional hernia following xiphoidectomy: A case report

Introduction: Xiphodynia is a rare musculoskeletal disorder characterized by epigastric or anterior chest pain, for which xiphoidectomy is considered as a definitive treatment. This procedure and its complications are not well researched, particularly within Australasian populations. We describe the novel laparoscopic incisional hernia repair from a xiphoidectomy complicated by recurrent epigastric hernias. Case Report: A 49-year-old female presented with chronic epigastric pain post-xiphoidectomy for xiphoidynia. The patient previously underwent open mesh repair for an incisional epigastric hernia, complicated by infection and subsequent removal of the mesh. A vacuum-assisted closure device was then utilized, followed by delayed primary closure. However, she experienced ongoing pain, a recurrent mass, and hypertrophic scarring, confirmed by abdominal computed tomography (CT) scan. Our laparoscopic approach involved a standard supine position with three ports and preperitoneal dissection similar to transabdominal preperitoneal (TAPP) hernia repair. The defect was 5 × 8 cm in size. A simple prolene mesh (9 × 12 cm) was secured with AsorbaTack and Glubran 2, followed by peritoneal closure with a 3/0 V-Loc suture. At two months follow-up, the patient had no evidence of recurrent hernia, no ongoing pain, and satisfactory wound healing. Conclusion: Laparoscopic surgical repair using a TAPP approach is a safe alternative to open repair of an incisional recurrent epigastric hernia post-xiphoidectomy.

Quality of life following repair of large hiatal hernia is not influenced by the use of mesh-Longer-term follow-up from a randomized trial.

The use of prosthetic mesh in laparoscopic repair of large hiatus hernias remains controversial. Clinical and quality of life outcomes from a randomized controlled trial of mesh versus suture repair previously showed few differences at early follow-up. This study evaluated longer-term quality of life outcomes from that trial. A prospective, multicentre, double blind randomized controlled trial assessed three methods of repair for large hiatus hernias: sutures-only versus absorbable mesh versus non-absorbable mesh. Quality of life was assessed using the Short-Form 36 (SF-36) questionnaire which was completed preoperatively and then at 3, 6, 12months following surgery and annually thereafter. SF-36 outcomes were compared across the three repair techniques at longer-term follow-up (3-6years), and to earlier baseline and 12-month outcomes. 126 patients were randomized; 43-suture-only, 41-absorbable mesh and 42-non-absorbable mesh. Questionnaires were completed by 118 patients preoperatively, 115 at 12months and 98 at longer-term follow-up (median 5years). There were no significant differences between the repair techniques for the subscale and composite scores at longer-term follow-up. The mental component score improved significantly after surgery and was sustained across follow-up for all techniques. The physical component score also improved significantly but was lower at longer-term follow-up compared to the 12-month follow up in both mesh groups. Surgical repair of large hiatus hernias provides sustained long-term improvement in quality of life. The addition of mesh does not improve quality of life. This trial is registered with the Australia and New Zealand Clinical Trials Registry ACTRN12605000725662.

Hybrid Technique for Abdominal Wall Hernia Repair: Description and Early Results.

Objective Ventral hernia repair is a widely practiced surgical procedure worldwide. The objective of this paper is to evaluate and analyze the results of a hybrid approach for treating ventral hernias. Methods All patients with clinically and radiologically proven ventral hernia underwent hybrid laparoscopic ventral hernia repair at Princess Royal University Hospital, London, United Kingdom using a retrospective approach with the same surgical team. Large defects >10 cm, inguinal hernia, para-stomal hernia, incarcerated patients, and spigelian hernia were excluded. We utilized the laparoscopic approach for the dissection and isolation of the sac and used the port site for the delivery of mesh into the abdominal cavity. Results Our study comprises 67 patients, with 39 males (58.2%) and 28 females (41.8%). The median age in our study group was 41 years (range: 18-65 years). The median BMI was 38 kg/m2 (range: 24-52 kg/m2). The majority of the cases were umbilical or paraumbilical hernias (n = 46). The median defect size in our study was 5.4 cm (range: 2-10 cm). The median operative time was 67 minutes. We have not encountered any recurrences in this group. Conclusion This hybrid approach combines the advantages of both the open and laparoscopic approaches.

Obturator hernia: a persisting clinical diagnostic challenge – a case report

Introduction: The presentation of a strangulated obturator hernia is rare, with it accounting for less than 0.04% of all hernias. Delay in presentation and diagnosis results in complications like bowel ischemia, necrosis, perforation, and peritonitis, thereby increasing morbidity and mortality. Case presentation: The authors report the case of an 85-year-old multiparous woman who presented with a 3-day history of abdominal pain and vomiting. Upon examination, she exhibited hypotension, altered sensorium, and a distended abdomen with visible peristalsis. An abdominal pelvic computed tomography scan confirmed the diagnosis of ‘intestinal obstruction secondary to an incarcerated obturator hernia’. Subsequently, a lower midline laparotomy was performed, successfully reducing the bowel and repairing the hernial orifice. The patient was discharged on the fourth postoperative day, and there has been no hernia recurrence as of her 3-month follow-up. Discussion: The presentation of a strangulated obturator hernia can be elusive. During clinical examination, both the Howship–Romberg sign and the Hannington-Kiffs sign tests may be negative. Laparoscopic obturator hernia repair has been shown to reduce hospital stay and morbidity. A midline laparotomy has the advantage of easy manual reduction, minimizing bowel trauma, accurately accessing the bowel, and facilitating bowel resection. Conclusion: Obturator hernias constitute rare subtypes of abdominal hernias. They typically occur in older women, and patients often present with poor functional status and multiple comorbidities. The clinical diagnostic tests are uncertain, even in patients with a high index of suspicion. Timely diagnosis and appropriate surgical management are crucial for a favorable outcome.

The Effect of Combined Spinal Epidural Anesthesia on Shoulder Pain in Laparoscopic Extraperitoneal Hernia Surgery.

Shoulder pain is a condition that seriously discomforts patients and develops caused by a peritoneal tear in laparoscopic extraperitoneal hernia repair (TEP) surgeries. Although surgeons generally prefer general anesthesia for the TEP technique, many studies have been carried out on the use of regional anesthesia in recent years. In our study, we aimed to investigate the efficacy and safety of the combined spinal/epidural anesthesia (CSEA) method to prevent shoulder pain in the TEP technique. The patients who operated with the TEP procedure were divided into 2 groups; SA (group 1) and CSEA (group 2). The 2 patient groups were compared in terms of sex, age, body mass index, duration of surgery, total operation time, patient satisfaction, pain scores, length of hospital stay, adverse effects, intraoperative, and postoperative complications. The number of patients in group 1 was 42 and group 2 was 40. The mean operation time was recorded as 55.9 and 80.2 minutes in groups 1 and 2, respectively, which was statistically significantly shorter in group 1 ( P <0.001). Postoperative pain was significantly less in group 2 for the 4th hour ( P <0.0001) and the 12th hour ( P =0.047). There was no difference between the 2 groups in terms of peritoneal tear ( P =0.860). Intraoperative and postoperative shoulder pain was significantly less in group 2 ( P =0.038, P =0015, respectively). CSEA is an effective and safe anesthesia method for preventing shoulder pain that develops after TEP surgeries.

Laparoscopic repair of a primary parahiatal hernia combined with gastric volvulus: a case report and literature review

BackgroundParahiatal hernias present a hernial orifice at the diaphragm that is adjacent to the esophageal hiatus, differing from the paraesophageal type of hiatal hernias. Although diagnostic imaging has advanced in recent years, diagnosing parahiatal hernias remains challenging. We herein report a case in which we performed laparoscopic surgery and intraoperatively diagnosed a parahiatal hernia.Case presentationA 67-year-old man presented to our hospital with difficulty eating, epigastric pain, and vomiting. We suspected a paraesophageal hiatal hernia. Laparoscopic surgery was performed, and a diagnosis of parahiatal hernia was made. We closed the hernial orifice with direct simple closure using nonabsorbable threads. The patient’s postoperative recovery course was reasonable, and he was discharged on the twelfth postoperative day.ConclusionsParahiatal hernias are rare, and a definitive diagnosis is difficult. Laparoscopic surgery can help accurately diagnose and treat patients presenting with the condition.

Evaluation of the Erector spinae plane block for postoperative analgesia in laparoscopic ventral hernia repair: a randomized placebo controlled trial

BackgroundThe Erector spinae plane block (ESPB) reduces postoperative pain after several types of abdominal laparoscopic surgeries. There is sparse data on the effect of ESPB in laparoscopic ventral hernia repair. The purpose of this study was to test the postoperative analgesic efficacy of an ESPB for this procedure.MethodsIn this prospective, double-blind, randomized controlled study, adult patients undergoing laparoscopic ventral hernia repair were randomly assigned to either bilateral preoperative ESPB with catheters at the level of Th7 (2 × 30 ml of either 2.5 mg/ml ropivacaine or saline), with postoperative catheter top ups every 6 h for 24 h. The primary outcome was rescue opioid consumption during the first hour postoperatively. Secondary outcomes were total opioid consumption at 4 h and 24 h, pain scores, nausea, sedation, as well as Quality of Recovery 15 (QoR-15) and the EuroQol-5 Dimensions (EQ-5D-5L) during the first week.ResultsIn total, 64 patients were included in the primary outcome measure. There was no significant difference in rescue opioid consumption (oral morphine equivalents (OME)) at one hour postoperatively, with the ESPB group 26.9 ± 17.1 mg versus 32.4 ± 24.3 mg (mean ± SD) in the placebo group (p= 0.27). There were no significant differences concerning the secondary outcomes during the seven-day observation period. Seven patients received a rescue block postoperatively, providing analgesia in five patients.ConclusionWe found no difference in measured outcomes between ESPB and placebo in laparoscopic ventral hernia repair. Future studies may evaluate whether a block performed using higher concentration and/or at a different thoracic level provides more analgesic efficacy.Trial registrationNCT04438369; 18/06/2020.

LAPAROSCOPIC SUGARBAKER TECHNIQUE FOR PARAOSTOMAL HERNIAS. HOW WE DO IT

Abstract Aim To delineate the critical steps involved in Sugarbaker laparoscopic paraostomal hernia repair. By providing a detailed understanding of these steps, surgeons can improve their procedural proficiency, leading to enhanced patient outcomes and reduced postoperative complications. Material and Methods We compiled several videos to identify and highlight the critical steps to performing and adequate Sugarbaker laparoscopic repair for paraostomal hernias. Results The critical steps in Sugarbaker laparoscopic paraostomal hernia repair were identified and categorized into preoperative, intraoperative, and postoperative phases. These steps include patient selection, stoma site, trocar placement, dissection and reduction of herniated contents, mobilization of the colon, closure of the hernia defect, measurement according to anatomical landmarks for mesh preparation, placement of mesh reinforcement. Emphasis was placed on meticulous technique, anatomical landmarks, and avoidance of potential pitfalls. Conclusions Sugarbaker laparoscopic paraostomal hernia repair is a technically demanding procedure requiring adherence to critical steps for optimal outcomes. Surgeons should prioritize thorough preoperative planning, precise intraoperative technique, and vigilant postoperative care to minimize complications and achieve successful hernia repair. Further research and refinement of surgical techniques are warranted to continually improve the efficacy and safety of this approach.

COMPARISON OF TOTAL EXTRAPERITONEAL (TEP) AND EXPANDED VIEW TOTAL EXTRAPERITONEAL (eTEP) METHODS AT INGUINAL HERNIA REPAIR

Abstract Background Laparoscopic hernia repair has been accepted as first-line treatment for inguinal hernia by major surgical institutions today, with low complication and recurrence rates. The aim of this prospective clinical study, we compared two different laparoscopic approaches in terms of technical ease, patients' early postoperative quality of life, pain management, complication and early recurrence rates. Method Patients with inguinal hernia who were planned to undergo laparoscopic hernia repair were randomized and operated with total extraperitoneal repair (TEP) and extended view total extraperitoneal repair (eTEP) methods in July and August 2023. During the postoperative follow-up, 24th-hour pain scores and 24th-hour quality of life scores were noted with a visual analogue scale (VAS) and quality of recovery test (QoR T15). At the 1st week outpatient clinic follow-up, their pain scores were questioned with VAS. They were checked by physical examination for complications or early recurrence. Patients were called for follow-up at the 1st and 3rd months after the surgery. Results The number of fixative staples was significantly higher in TEP group (p &amp;lt; 0.001). The operation time was significantly shorter in eTEP group (p: 0.031). Time to return to work was significantly longer in TEP group (p: 0.024). VAS scores on the 1st postoperative day were found to be significantly lower in eTEP group (p &amp;lt; 0.001), no significant difference was detected in the 1st week scores. The QoR test scores on the first postoperative day were significantly higher in eTEP group (p:0.006). The difference between number of patients with seroma, ecchymosis or hematoma was not significant in two groups. Conclusions Both methods we used did not make a significant difference in the incidence of complications. On the other hand, we revealed that eTEP method may be more advantageous in terms of ease of surgery, patients' quality of life in the early period.

PHASIX™ ST MESH FOR CRURAL REINFORCEMENT DURING GIANT HIATAL HERNIA REPAIR: PRESENTATION OF SURGICAL TECHNIQUE

Abstract Aim Crural mesh reinforcement during large hiatal hernia repair has been advocated to defend against early recurrences. However, the optimal mesh material and configuration remain in question. This study presents the rationale and surgical technique for crural repair augmentation using Phasix™ ST Mesh. Methods We present a case of a giant hiatal hernia and outline the rationale and surgical technique for using Phasix™ ST Mesh in the repair. Results A 72-year-old man presented with a giant type IV hiatal hernia. A massive mediastinal protrusion of intra-abdominal fat and viscera, and an associated crucial cardiorespiratory compromise were noted. A preoperative CT scan revealed a widened hiatus measuring 9.2 × 7.6 cm. The patient underwent laparoscopic hiatal hernia repair and Nissen fundoplication. During the procedure, following visceral reduction and hernia sac dissection and excision, a widened round hiatus and significantly thinned crura were found. To reinforce the primary crural suturing, two strips of Phasix™ ST Mesh, each measuring 1.5 × 4 cm, were used, and a U-shaped mesh was placed onlay to augment the repair. The procedure lasted 214 minutes, and the patient was discharged on the 3rd postoperative day without complications. Conclusions The application of Phasix™ ST Mesh in the repair of giant hiatal hernias offers the dual benefits of reconstructing the original anatomy and reinforcing the hiatus, while avoiding the implantation of permanent foreign material around the esophagus.

SAGA OF A DECADE! BILATERAL GROIN MESH EXPLANTATION WITH COLOCUTANEOUS FISTULA

Abstract Background Mesh-related complications following previous laparoscopic hernia repair, especially transabdominal preperitoneal (TAPP) surgery, can present significant challenges. This case report highlights the utilization of the Mesh Explantation Classification in a 60-year-old male with a colocutaneous fistula a decade after index surgery &amp; emphasises the use of mesh explantation classification for standardisation &amp; case reporting (Published in Hernia Surgery). Objective Describe the laparoscopic mesh explantation and stapled disconnection of a colocutaneous fistula in a patient with mesh-related complications post-TAPP surgery 10 years back and emphasize the mitigation strategies and technical nuances. Methods A 60-year-old male, previously subjected to TAPP surgery, presented with a colocutaneous fistula with faecal discharge secondary to mesh-related complications. Pre-operative colonoscopy, marking the site of the fistula and use of fluoroscopy for identification of any metal tacks were performed. The Laparoscopic mesh explantation and the disconnection of the colocutaneous fistula using an intestinal stapler and intraoperative sigmoidoscopy performed to avoid any luminal narrowing. Two pieces of polyester mesh, with metal tackers were successfully explanted without any collateral vascular injury. Results The patient experienced resolution of symptoms postoperatively, and there were no signs of recurrent fistula during follow-up; the explanted mesh showed features of atypical mycobacterium on the microbiology, and hence, the patient was put on one year of treatment for atypical mycobacterium, he tolerated the treatment well and recovered. Conclusion This case emphasises the importance of a team approach at Index surgery in every case of Mesh Explantation to get the best surgical outcomes. Mesh explantation standardisation classification helps in proper documentation by the surgeon and guides future additional treatment if required. Further research and collective documentation using standardized classifications are essential to refine and validate the approach for mesh explantation in hernia surgery.

Laparoscopic Versus Open Mesh Repair of Inguinal Hernia for Military Personnel

Background: An organ or fatty tissue, like the colon, might abnormally emerge through the wall of the cavity in which it normally dwells, a condition known as a hernia. Inguinal hernia repair is among the most frequently done procedures by surgeons worldwide. Treatment includes pure tissue repairs to prosthetic repairs under open or laparoscopic approach. Though so many options are available but none is superior to others. Aim of the study is to compare the effectiveness of laparoscopic hernia repair with open mesh hernia repair. Methods: The study was a comparative cross-sectional study. The study, which took place between 2016 and 2018, involved 100 cases in the General Surgery department of Combined Military Hospital (CMH), Savar (30 cases of laparoscopic hernioplasty and 70 cases of open hernioplasty). Purposive sampling technique was used to collect data. Data were collected during follow up of patients by using a semi-structured questionnaire. Data were analysed by using Statistical Package for the Social Sciences (SPSS) version 26.0. Informed written consent were obtained from the patients and ethical issues were duly addressed. Results: There were 100 patients in the study, 30 of whom were assigned to group A (the laparoscopic group) and 70 to group B (the open group). In group A, the mean operating time was 103.67±23.57 minutes, while in group B, it was 50.26±2.57 minutes. In group A, there was a decrease in pain scores, with 90% of patients reporting 1-2 (mild discomfort). Three people are in excruciating pain. Conclusion: Inguinal hernia repair is a frequently performed general surgery treatment. Because of the large socio-economic impact of inguinal hernia repair, it is the responsibility of the surgeon to consider the most advantageous approach in each given situation. For all patients needing elective hernioplasty, laparoscopic, non-randomized, pre-peritoneal mesh repair for inguinal hernias is a safe, effective method that has clear advantages over open mesh repair. Bangladesh Armed Forces Med J Vol 56 No (2) December 2023, pp 17-23

Should We Operate Nonagenarians with Symptomatic Giant Paraesophageal Hernias?

Introduction: Hiatal hernia (HH) is a common disorder of the upper gastrointestinal (UGI) tract that general surgeons encounter. Giant paraesophageal is a subtype of HH in which more than 30% of the stomach is located in the chest. It can cause symptoms such as dysphagia, UGI bleeding, gastroesophageal reflux disease, and vomiting. As the life expectancy of the general population increases, the incidence of giant HH increases and can cause morbidity, including recurrent admissions and prolonged length of hospitalization. In this article, we describe a cohort of nonagenarian patients with HH who were admitted to our institution and were treated either surgically or medically. Methods: We retrospectively reviewed our prospectively maintained database of all nonagenarians who were admitted to our center between 2018 and 2022 with the diagnosis of HH. We compared the demographic data, clinical data, and outcomes between patients undergoing operative and nonoperative management. Results: Twenty patients of age over 90 years were hospitalized with HH-related symptoms. Six underwent surgery, whereas 14 received medical management. Surgical patients had fewer overall hospitalization days, shorter length of stay, and less blood product requirements. Notably two cases of in-hospital mortality occurred in the nonoperative group, whereas none occurred in the operative group. All surgical procedures were performed laparoscopically, with two minor perioperative complications. Conclusion: In selected nonagenarian patients, laparoscopic HH repair is safe and should be considered favorably. It can reduce hospitalization time and can mitigate morbidity.

Laparoscopic modified e-tep repair of concomitant inguinal and ventral hernias.

Laparoscopic hernia repair in recent times has gained the most acceptance among both the surgical community and the patient groups, as it has proven benefits of lesser postoperative hospital stay and less pain scores. The incidence of both inguinal and ventral hernias has increased significantly in the present days. Various methods have been postulated by different surgical groups for repairing the same but no there is no standard consensus on managing concomitant inguinal and ventral hernias. The conventional e-TEP requires an extensive dissection with increased operative time. We present our experience in managing cases with both inguinal and primary M2/M3 and W1 ventral hernias with or without divarication of recti using a modified up to down approach for inguinal hernia followed by down to up approach for the ventral hernia, from a tertiary care center in South India. We managed 16 cases with simultaneous incidence of inguinal and primary M2/M3 and W1 ventral hernias with or without divarication of recti between January 2022 and November 2023. Institute ethical committee clearance and informed consent was obtained from all the 16 patients. They were all subjected to an extra peritoneal repair of both the hernias. All the demographic data, intraoperative data, postoperative complications and follow up were digitally stored. All patients were followed up for six months after surgery. Out of 16 patients, 15 were males and 1 was female. The mean age was 48years and the mean BMI of all the patients was 29.2kg/m2. The postoperative recovery was smooth in all patients and being discharged within 24h after surgery. The pain scores of all patients were significantly lower than patients who underwent intraperitoneal repair. e-TEP hernia repair is gaining popularity and has amused the hernia surgical community. Our method of e-TEP RS repair in cases with concomitant inguinal and primary M2/M3 W1 ventral hernias with or without divarication helps in addressing both the hernias in the extra-peritoneal space. Our technique reduces the area of dissection needed for mesh placement and preserves the integrity of abdominal musculature in the upper abdomen when compared with the conventional technique. It further allows extension of the e-TEP inguinal space into the Rectro rectus space without much alteration in the port arrangement allowing simultaneous repair of groin and umbilical hernias. Good knowledge of anatomy and laparoscopic skills are pertinent for safe and effective hernia repair by this technique.

Quality of life following laparoscopic totally extraperitoneal repair of a unilateral reducible inguinal hernia.

Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair has become increasingly favored over open Lichtenstein tension-free mesh repair owing to its associated benefits, including reduced postoperative pain, early return to normal activities, and a comparable recurrence rate. In recent years, emphasis has been placed on patient-reported outcomes, particularly health-related quality of life (QOL), as a critical metric for evaluating surgical success. This study aimed to evaluate the overall QOL following laparoscopic TEP repair of unilateral inguinal hernia. This prospective study enrolled patients aged 18 years or older who underwent elective laparoscopic TEP hernia repair for unilateral inguinal hernia from April 2020 to March 2022. Data collected include demographic details, hernia characteristics, postoperative complications, and postoperative QOL assessment. The Short Form 36 Health Survey Version 2 (SF-36v2), a validated general QoL questionnaire, was administered preoperatively and at 1 month, 6 months, and 1 year postoperatively. Statistical analysis utilized paired t-tests for comparisons, with significance set at a p-value <.05. A cohort of 49 patients, with a mean (standard deviation) age of 56.7 (14.0) years, predominantly comprising 47 men, was available for evaluation. Complications were observed in three (6.1%) of cases, with seroma/hematoma occurring in two patients and a wound infection necessitating antibiotic treatment in one patient. Notably, there were no instances of recurrence during the study period. Postoperative assessments revealed significant improvements in both physical and mental health at 1 month, with continued improvement noted up to 12 months. Laparoscopic TEP inguinal hernia repair has been shown to improve both physical and mental health in patients with unilateral reducible inguinal hernia, with the majority of the improvement typically occurring within the initial month following surgery. It is crucial to communicate these improvement trends to patients undergoing hernia repair to help manage their expectations effectively.

Accuracy of ultrasonography in predicting contralateral patent processus vaginalis compared with laparoscopic findings in children

ObjectiveThe study aims to evaluate the usefulness of preoperative ultrasonography (US) at the internal inguinal ring level in predicting contralateral patent processus vaginalis (CPPV).MethodsThis is a prospective study of patients who presented with unilateral inguinal hernia and underwent laparoscopic hernia repair and contralateral side exploration. The gender, age, initial presenting side, and the preoperative width of the low echoic region at the internal ring (WLIR) of the contralateral side that was determined using US and laparoscopic findings were recorded. The preoperative diagnosis of CPPV was considered if the WLIR is > 4 mm. We compared laparoscopic with US findings.ResultsThis study included 30 patients with a median age of 3.5 years (range, 25 days to 10 years), with 3 females and 27 males. The preoperative US and laparoscopic diagnoses of the contralateral side were concordant in 19 (63.3%) and discordant in 11 (36.6%) patients. US showed a sensitivity of 50.00%, specificity of 72.22%, and accuracy of 63.3% in diagnosing CPPV.ConclusionsMeasuring the WLIR by US was inadequate for an accurate CPPV diagnosis in our study. Therefore, more distinctive US criteria are required for a proper CPPV diagnosis.

Postoperative pain in transabdominal preperitoneal laparoscopic hernia repair with staple fixation versus self-fixation mesh

BackgroundThe mesh fixation method is one of the multiple factors associated with chronic postoperative pain in inguinal hernia surgery. The aim of this study is to evaluate postoperative pain associated with the two available fixation strategies (staple fixation versus self-fixating mesh) used in our field. MethodsWe designed an observational study with retrospective cohorts to analyze postoperative pain in patients who underwent a laparoscopic transabdominal preperitoneal inguinal hernia repair with a self-fixating mesh or staple fixation, which are the two available techniques in our field. A total of 296 patients who met the inclusion criteria were included between January 2014 and October 2021. ResultsThe evaluated patients’ median age was 66.0 (interquartile range (IQR): 20.75) years and were predominantly male (70.13 %). The proportion of participants with chronic pain was 3.20 % in the staple fixation group and 0 % in the self-fixating mesh group, with no statistically significant differences. On the other hand, recurrency in the staple fixation group was 2.28 % versus 3.90 % in the self-fixating mesh group, without statistically significant differences. ConclusionsSelf-fixating meshes have a trend towards smaller proportion of chronic pain and similar proportions of recurrence; therefore, they seem to be the best fixation method between the two mechanisms that are available in our field to prevent postoperative chronic pain.

Laparoscopic Obturator Hernia Repair with Self-Gripping Mesh: Case Series in a Single Institution

Laparoscopic Obturator Hernia Repair with Self-Gripping Mesh: Case Series in a Single Institution

Opportunistic Salpingectomy at the Time of General Surgery Procedures: A Systematic Review and Narrative Synthesis of Current Knowledge

Opportunistic salpingectomy (OS) for the primary prevention of ovarian cancer is performed by gynecologists. Advocates have suggested expanding its use to other surgical specialties. General surgeons are the other group to routinely perform intraperitoneal operations in women and could play a role in ovarian cancer prevention. Herein, we review the current evidence and perioperative factors requiring consideration prior to OS implementation in select general surgery cases. A systematic search was conducted for English-language studies evaluating OS during general surgery. The primary outcomes of this study were the feasibility and safety of OS during general surgery procedures. Secondary outcomes included pre-operative considerations (patient selection and the consent process), operative factors (technique and surgical specialty involvement), and post-operative factors (follow-up and management of operative complications). We evaluated 3977 studies, with 9 meeting the eligibility criteria. Few studies exist but preliminary evidence suggests relative safety, with no complication attributable to OS among 140 patients. Feasibility was reported in one study, which showed the capacity to perform OS in 98 out of 105 cholecystectomies (93.3%), while another study reported quick visualization of the fallopian tubes in &gt;80% of cases. All patients in the included studies were undergoing elective procedures, including cholecystectomy, interval appendectomy, colorectal resection, bariatric surgery, and laparoscopic hernia repair. Studies only included patients ≥ 45 years old, and the mean age ranged from 49 to 67.5 years. Gynecologists were frequently involved during the consent and surgical procedures. OS represents a potential intervention to reduce the risk of ovarian cancer. Ongoing studies evaluating the general surgeon’s understanding; the consent process; the feasibility, operative outcomes, and risks of OS; and surgeon training are required prior to consideration.

Medium term (> 12 months) outcomes after laparoscopic hiatal hernia repair without conventional fundoplication using PH4B-mesh implant (Phasix™) in 176 reflux patients: experience and technique.

Hiatal mesh repair remains a controversial topic among anti-reflux surgeons. Biosynthetic mesh cruroplasty may prevent early recurrence while avoiding late esophageal erosion and strictures associated with non-resorbable materials. So far, medium-term results on hiatal PH4B (Poly-4-Hydroxybutyrate) mesh repair from high-volume centers are lacking. We analyzed the medium-term efficacy and safety of PH4B mesh cruroplasty in 176 consecutive patients (≥ 18years) with symptomatic hiatal hernias. Treatment failure was defined as the clinical recurrence of reflux symptoms. Patients could choose between mesh augmented hiatal repair (combined with a modified anterior hemifundoplication and fundophrenicopexy), Nissen fundoplication, and magnetic sphincter augmentation at their discretion. We also describe the surgical approach to mesh augmented hiatal repair used at our center. On average, patients were 55 (± 14) years old and followed up for 22 (± 7; sum: 3931) months. Treatment failed in 6/176 (3%, 95% CI: 2-7%) patients. The 24-month Kaplan-Meier failure estimate was 2.8% (95% CI: 0.4-5%). Each centimeter in hernia size increased the risk of failure by 52% (p = 0.02). Heavier patients (BMI > 27) had an 11% higher probability of clinical symptom recurrence (p = 0.03). The dysphagia and bloating/gas rate were 13/176 (7%), each. 8 (5%) patients required endoscopy due to dysphagia but without intervention. No serious complications, including mesh infection and erosion, or fatalities, occurred. Augmented PH4B mesh cruroplasty without conventional fundoplication shows excellent intermediate-term results in patients with reflux disease due to hiatal hernia. Around one in thirty patients experience treatment failure within 2years of surgery. Hernia size and overweight are key determinants of treatment failure.